POS1440 HEMATOLOGICAL MALIGNANCIES AND ANTI-TNF IN INFLAMMATORY ARTHRITIS: THE REAL LIFE DATA FROM THE HUR-BIO REGISTRY
Authors: E. Duran, Z. Ö. Öztürk, E. Bilgin, E. C. Bolek, G. K. Yardimci, B. Farisogullari, Z. Özsoy, G. Ayan, G. Sandal Uzun, M. Ekici, E. Unaldi, L. Kiliç, A. Akdoğan, O. Karadag, Ş. A. Bilgen, S. Kiraz, U. Kalyoncu, A. I. Ertenli
Journal: Annals of the Rheumatic Diseases (2022)

Background TNF inhibitors (TNFi) is highly effective in inflammatory arthritis (IA) treatment. However, concerns are raised about the possible association between TNFi and hematologic malignancies (HMs). Objectives To assess the incidence of HMs among IA patients receiving TNFi compared with the general Turkish population. Methods HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (bDMARD) registry since 2005. Patients with IA including rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) patients who had at least 1 visit after the TNFi usage were screened from 2005 to November 2021. HM diagnosis was determined from the each patient files according to the hematologists’ decision and/or bone marrow/lymph node biopsy. Demografic data, disease characteristics, and death status were recorded. Standardized incidence rates (SIR) were calculated after adjustment for age and gender and compared with age- and gender-specific SIR values abstracted from the 2017 Turkish National Cancer Registry (TNCR). Results Of the 6139 patients registered in the HUR-BIO database, 5355 [3116 female (58.2%)] used any TNFi at least once. Median follow-up duration was 2.6 years for all patients receiving TNFi. 13 patients [8 (61.5%) female] had HM on follow-up. In these patients, median age at the IA onset was 38 (range 26 to 67) and the number of patients with SpA, RA, and PsA was 7, 4, and 2, respectively. The median duration of IA was 17.7 years (range 1 to 33). The median age at the HM onset was 55.5 (range 38 to 76) and the type of HM as follow: 8 lymphoma, 2 multiple myeloma, 1 large granular lymphocytic leukemia, 1 plasma cell dyscrasia, and 1 myelodysplastic syndrome. The median duration of the TNFi usage onset to HM was 36 (range 4-112) months. The TNFi was as follows: etanercept (n=8), adalimumab (n=6), infliximab (n=4), golimumab (n=1), and certolizumab (n=1). 5 patients used more than one TNFi. Patients using TNFi had an increased incidence for HMs (SIR 4.23, 95% CI 2.35-7.05). These results were also valid for both gender. 10 patients with HMs were under the age of 65. In this group, there was a higher incidence of HMs in both men (SIR 5.15, 95% CI 1.88-11.43) and women (SIR 4.76, 95% CI 1.74-10.55). 5 patients deceased on follow-up. Conclusion The risk of HMs in inflammatory arthritis patients receiving TNFi being four times higher in comparison with the general Turkish population. There is a plethora of information that discusses the association between HMs and rheumatic disease. To determine whether the increased risk is from rheumatic disease or from TNFi usage, it would be ideal to compare patients receiving TNFi with bDMARD naive IA patients. Table 1. SIR for diferent age cut-ofs in both sexes for patients with hematologic malignancies Gender Age Observed/expected cases SIR %95 confidence interval Total All ages * 13/3.07 4.23 2.35-7.05 Male 20-64 years (n=2059) 5/0.97 5.15 1.88-11.43 ≥ 65 years (n=180) 0/0.39 NA - Overall (n=2239) 5/1.36 3.67 1.34-8.14 Female 20-64 years (n=2667) 5/1.05 4.76 1.74-10.55 ≥ 65 years (n=449) 3/0.66 4.54 1.15-12.37 Overall (n=3116) 8/1.71 4.67 2.17-8.88 * : Includes patients ≥18 years. NA: Not applicable, SIR: standardized incidence rates Figure 1. Cumulative number of hematologic malignancies in function of time from start of first anti-TNF therapy Disclosure of Interests None declared